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Structure: Developmental Begin with care givers of children Early intervention Elementary school Adolescence Care Givers of adults with disabilities Care Givers of the elderly

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Parents of Children With Special Needs Moersch (1996) suggests 3 ways to insure parental involvement: 1. Be sure home program work for the child 2. Be sure parent will achieve some success (just right challenge) 3. Be sure program includes areas of major concern to the parents

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Early Intervention Assumes a Family Centered Approach Simeonsson and Bailey (1990) Hierarchy of parental involvement Elective noninvolvement (lowest) Family involvement (midrange) Psychological change (highest) Some families need help to learn How to be advocates for their child Appropriate care giving roles within the family

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Strategies to Encourage Family Involvement Amplification (Wooster, in Scaffa, 2001) – Process of “noticing, describing, and discussing an interactive event between family member and child that is likely to promote change” Example: “I saw your child look at you and move his head toward the spoon. Try placing the spoon in front of his mouth, and see if he’ll move toward it…”

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Strategies, cont. Solution-Focused questions – Statements that support and enhance positive care giving Example: “Turning off the TV during feeding really seemed to help your daughter concentrate. What other things have you noticed that help her pay attention?”

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Strategies, cont. Recognizing routines – Fitting exercises into family’s normal daily routine Example: Combining range of motion exercises with diaper change time Recognizing needs – Suggesting safe way for child to play independently when parent is most likely to be busy (meal preparation, attend to other siblings)

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Best Practice Guidelines for Early Intervention (Scaffa, p. 282) Regard parents as partners in decision making Use clear, open, and collaborative communication style with all team members Share responsibilities for service implementation with team members Use knowledge to improve performance and functional outcomes Deliver cost-effective quality treatment View child’s abilities in context of natural environments Incorporate carryover into natural daily routines Use amplification and solution-focused questions

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Therapist-Family Relationships The child: Acknowledge the child as an active participant Whenever possible, include the child in decision making process Give child appropriate explanation of goals Role model giving child credit for his or her accomplishments Show respect for child as a person

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Therapist-Family Relationships, cont. Home Programs: Address parent concerns in developing home programs Give parents written reports of program guidelines, evaluation, and progress Demonstrate the treatment activities & explain their rationale Encourage parents to join you in frequent problem solving Vary activities to maintain continued interest Include parents views when evaluating effectiveness of interventions From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

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Therapist-Family Relationships, cont. Parents: Include both parents in initial evaluation Accept parents “where they are” Treat their contributions with respect Openly discuss preconceived expectations both positive and negative Parents and child should select goals and objectives; OT selects methods and techniques Avoid competing; support one another From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

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Family Relationships: Discussion How is the family defined? What are the functions of a family? Describe the impact of the following sources of diversity in families: Structure (non-traditional types?) Lifestyle (examples?) Ethnic background Socioeconomic background Parenting style From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

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Discussion, cont. What is the impact of having a child with a disability on the following family members? Mother Father Siblings Extended family How can recognizing this impact effect OT interactions with family of a child with special needs? From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

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Adolescents Importance of self concept Dealing with physical changes Sexual attractions Separation from parents as main source of support Vulnerability to depression/suicide Formation of ideals and values vs peer pressure Importance of social skills Preparation for adulthood How are these tasks different for a teen with special needs? How can parents help? What are possible OT roles? From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

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Issues for Parents How will child with disability become independent? How will he/she support self financially? What are appropriate living arrangements? What about adult friendships, sexual partners, marriage, pregnancy? What is still needed from parents? From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

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Possible Groups Mothers of children with special needs: parenting children of different ages, developing social skills, dealing with problem behaviors, etc Fathers: developing play skills, positive discipline Multiple family groups Parents of teens with special needs Parents of “at risk” children (focus on prevention re: drugs, alcohol, violence) From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

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Family Autonomy and Choice Some family members don’t want to be involved Some parents are not capable of being advocates, case managers, or decision makers for their child with special needs Need to acknowledge that parenting a child with a disability is hard work Recognize multiple levels of involvement by family members (refrain from judging) From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

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Care Giving of Older Adults Older adults with physical illness/injury are sent home “quicker and sicker” than ever before Burden of care falls on family 75% of family care givers are women Care giving often requires assistance with: Mobility, eating, dressing, toileting, transferring, and bathing From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

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Family Roles in Care Giving Companion – May have to give up job (life) to care for older person Case Manager – Arrange for home health care, rehabilitation, doctor visits, prescriptions, delivery of meals or other assistance Family roles – Daughter, sister, spouse, may conflict with care giving role Housekeeper, chauffer, cook, and personal assistant – taking over all IADL as older adult becomes incapable of handling. How can OT assist care givers/families? From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

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Some OT roles Provide intervention for whole family, if willing (e.g., grandma with dementia) Recognize care givers for the difficult job they are doing Guide care givers by educating them about their loved one’s illness Prevent burnout by recognizing signs of stress and suggesting coping strategies Help care givers to obtain needed assistance and/or community support From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

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Community OT Roles Work with care giver support groups Provide wellness and prevention training for care givers of elderly Work with specific disability associations to provide care giver education groups Offer training CEUs for home health aids, LPNs, or other institutional care givers From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

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The End Begin by volunteering Discuss community fieldwork experiences where OT could play a role From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.